Why would you have both Medicare and Medicaid?

Asked by: Jairo Schultz DVM  |  Last update: March 8, 2025
Score: 4.7/5 (73 votes)

Medicare-Medicaid enrollees include people ages 65 and over who are in relatively good health but have limited financial resources and people who at one time, may have had more financial resources, but spent their income and wealth on health or long-term care costs.

Why would someone be on Medicaid and Medicare?

Yes – if you're 65 or older and meet your state's income requirements for Medicaid, you can sign up for both Medicare and Medicaid. Together, they offer more comprehensive health coverage at a lower cost.

What are the benefits of having both Medicaid and Medicare?

Medicaid may cover medical costs that Medicare doesn't cover or partially covers (for example, nursing home care, personal care, and home- and community- based services). Beneficiaries' coverage can vary by state.

What is a patient having both Medicare and Medicaid called?

Some people qualify for both Medicare and Medicaid and are called “dual eligibles.” If you have Medicare and full Medicaid coverage, most of your health care costs are likely covered.

How many people qualify for both Medicare and Medicaid?

12 million Americans have both Medicare and Medicaid coverage. This is known as being “dual eligible,” meaning they get benefits from both programs to help pay healthcare costs. Let's take a look at Medicare and Medicaid, how to qualify for dual eligibility and more.

How Medicaid Works with Medicare | Are you Dual Eligible?

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What happens when you are on Medicaid and turn 65?

Therefore, following the ACA's coverage expansion, many newly-insured older enrollees will face a complex insurance transition on their 65th birthday: they will lose Medicaid coverage and transition from Medicaid to Medicare as their primary insurer.

What is the best health insurance plan for seniors?

Medicare is the best health insurance option for seniors and retirees. Medicare is the cheapest health insurance with the best benefits for people age 65 and older or who have a qualifying disability. You can choose between two different options: Original Medicare and Medicare Advantage.

What does Medicaid not cover?

Though Medicaid covers a wide range of services, there are limitations on certain types of care, such as infertility treatments, elective abortions, and some types of alternative medicine. For example, the federal government lists family planning as a mandatory service benefit, but states interpret this differently.

Who qualifies for DSNP?

Dual Eligible Special Needs Plans (D-SNPs) enroll individuals who are entitled to both Medicare (title XVIII) and medical assistance from a state plan under Medicaid (title XIX). States cover some Medicare costs, depending on the state and the individual's eligibility.

What is a dual benefit?

If you qualify as a full-benefit dual-eligible beneficiary, you are enrolled in. Medicare and receive full Medicaid benefits. This means that Medicaid may cover. services that Medicare does not cover, such as4,14: If you are someone who qualifies as a dual-eligible beneficiary, Medicare will be the first program.

What happens if you make too much money while on Medicaid?

If you're over the Medicaid income limit, some states let you spend down extra income or place it in a trust to help you qualify for Medicaid. If you receive long-term care but your spouse doesn't, Medicaid will allow your spouse to keep enough income to avoid living in poverty.

What are the four types of Medicaid?

There are four types of Medicaid delivery systems:
  • State-operated fee-for-service (FFS)
  • Primary care case management (PCCM)
  • Comprehensive risk-based managed care (MCO model)
  • Limited-benefit plans.

What does Medicaid cover for seniors?

Mandatory benefits include services including inpatient and outpatient hospital services, physician services, laboratory and x-ray services, and home health services, among others. Optional benefits include services including prescription drugs, case management, physical therapy, and occupational therapy.

Is Medicare free at age 65?

People age 65 or older, who are citizens or permanent residents of the United States, are eligible for Medicare Part A. You're eligible for Part A at no cost at age 65 if 1 of the following applies: You receive or are eligible to receive benefits from Social Security or the Railroad Retirement Board (RRB).

Who funds Medicare and Medicaid?

Funding for Medicare, which totaled $888 billion in 2021, comes primarily from general revenues (46%), payroll tax revenues (34%), and premiums paid by beneficiaries (15%) (Figure 8). Other sources include taxes on Social Security benefits, payments from states, and interest.

Am I dual eligible for Medicare and Medicaid?

People who have both Medicare and full Medicaid coverage are “dually eligible.” Medicare pays first when you're a dual eligible and you get Medicare-covered services. Medicaid pays last, after Medicare and any other health insurance you have.

How do you qualify for a SNP plan?

You can join an SNP if you meet these requirements:
  1. You have Medicare. Part A (Hospital Insurance) Part A (Hospital Insurance) ...
  2. You live in the plan's. service area. Service area. ...
  3. You meet the eligibility requirements for one of the 3 types of SNPs: Dual Eligible SNP (D-SNP) Chronic Condition SNP (C-SNP)

What are the three types of special needs plans?

There are three different types of SNPs:
  • Chronic Condition SNP (C-SNP)
  • Dual Eligible SNP (D-SNP)
  • Institutional SNP (I-SNP)

Will I lose my Medicaid if I get Medicare?

Fortunately, Medicaid enrollees will not lose their benefits if they sign up for Medicare. As long as you are eligible for both programs in your state, you will continue to receive benefits from both Medicaid and Medicare. Things will work a little differently though.

Does Medicaid cover 100% of hospital bills?

What Medicaid Covers. Once an individual is deemed eligible for Medicaid coverage, generally there are no, or only very small, monthly payments, co-pays or deductibles. The program pays almost the full amount for health and long-term care, provided the medical service supplier is Medicaid-certified.

What are the downsides of Medicaid?

Disadvantages of Medicaid

One of the primary reasons for this is that Medicaid reimbursements are lower than those of commercial insurers for most procedures and treatments.

What is the best Medicare plan that covers everything for seniors?

Original Medicare with Medigap likely offers the most comprehensive coverage, but it may also be the most costly. A person can consider their income and how much they are able to spend before choosing a Medicare plan. Original Medicare with Medigap also offers a lot of flexibility when choosing a doctor or specialist.

Who has the cheapest insurance for seniors?

Our research found that Auto-Owners, Travelers, Geico, USAA and Nationwide may be the cheapest car insurance companies for seniors based on average rates from Quadrant Information Services. Rates provided are for a 70-year-old driver with a clean driving record.

What type of medical insurance do most retirees have?

Since Medicare pays first after you retire, your retiree coverage is probably similar to coverage from a Medicare Supplement Insurance (Medigap) policy. Both are likely to offer benefits that fill in some of the gaps in Medicare coverage—like coinsurance and deductibles.